An acute care surgeons dilemma: Operative vs. non-operative management of emergency general surgery conditions in patients with recent colorectal cancer treatment

Background: This comparative effectiveness study examined outcomes of operative vs. non-operative management for emergency general surgery (EGS) conditions in patients with recent cancer treatment (RT). Methods: Medicare beneficiaries with a history of colorectal cancer hospitalized for an EGS condition (2016-2018) were identified. RT was defined as chemotherapy/radiation within 3 months prior to admission. Instrumental variable analysis assessed the impact of management on mortality and readmissions among survivors (30d, 60d, and 90d), for patients in whom there was clinical equipoise regarding optimal management strategy.R esults: Of 26,097 patients, 13% had undergone RT. In both the RT and non-RT groups, the optimal management strategy was uncertain in 14%. Operative management conferred increased risk of mortality but not readmission in patients with RT compared to those without (90d mortality:+43%, p = 0.03; 90d readmission:+7.1%, p = 0.776). Conclusions: In patients with RT for whom there is clinical equipoise regarding EGS management, operative intervention increases risk of mortality.